Bill > A1830

Introduced Session

This bill provides that providers of diagnostic radiologic services that participate in a managed care network shall be reimbursed at the same rate for the same service. Currently, carriers are permitted to negotiate a fee schedule that can be specific to a particular provider and, therefore, reimbursement rates can vary based on the size and negotiating ability of a particular provider relative to the carrier. Specifically, this bill provides that a carrier which offers a managed care plan that provides benefits for diagnostic radiologic services shall offer the same fee schedule, including any additional compensation in addition to the fee schedule for those diagnostic radiologic services to all participating providers. Each billing code for a diagnostic radiologic service shall be reimbursed at the same rate to all participating providers. The bill further stipulates that a carrier shall not negotiate a fee schedule for diagnostic radiologic services that is specific to a particular health care provider to the detriment of other participating providers providing the same service. It has come to the sponsor's attention that recent revisions to certain fee schedules offered to diagnostic radiology centers have resulted in significant reductions in reimbursement rates to certain, usually smaller, facilities and created wide variation in reimbursement rates between facilities. In order to protect smaller, locally owned, facilities from severe economic consequences of such a change, this bill would require all facilities to be reimbursed at the same rate for the same diagnostic radiologic service.

AI Summary

Committee Categories

Herbert Conaway (D)*,  Pam Lampitt (D)*,  JoAnn Downey (D), 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/27/2016)